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Wednesday’s attack on U.S. forces in Syria has stoked fresh criticism over President Donald Trump’s claim that the so-called Islamic State has been defeated renewed debate over his decision to withdraw all troops from the war-torn country.

Around 1 p.m. local time, a suicide bomber blew himself up in a popular area of downtown Manbij, a northern Syrian city that’s been controlled by U.S.-supported Kurdish militias since it was wrested from ISIS in 2016.

Four Americans were killed — two service members, a civilian Pentagon official and a U.S. contractor — and three more injured, U.S. Central Command confirmed in a statement, reportedly marking the largest single loss of American life since the counter-ISIS campaign began. Nineteen people are believed to have died in total, including civilians and local coalition partners, according to monitoring group the Syrian Observatory for Human Rights.